Reducing demand for health services workshop presentation by Cynthia Dize at Age UKs "Living well with long term conditions" conference

1. Primary Care Navigators
Reducing demand for health services
14 November 2012

2. Why it’s well-regarded
 The Primary Care Navigator model meets a need
 Provides integration across health, social care and third
sector
 Makes a real difference to the experience of patients and
clinicians
 Flexible, adaptable, scaleable
 Is effective and efficient

3. Meeting the need
 15 million people with LTCs
 50% of GP appointments
 70% of acute and primary care budgets
 DH predicts a rise of 25% in people over 65 with one + LTCs by 2050
 Cuts to local government spending have led to raised eligibility for
funded services
 Consequence is more pressure on secondary and primary care
 King’s Fund (Self-Management for LTCs, 2005) - people want to self
manage but need improved provision of information about their
condition and what is available locally
Statistics are people with the tears washed off

4. Meeting the need
▪ London has rich and varied provision across statutory and non-statutory
providers
▪ But patients and carers find that services are hard to locate and access
▪ Made worse by poor communication between health and social care
▪ Particular issues:
▪ Part of the solution is in social care, benefit support, housing advice –
unrecognised by people who have never associated themselves with
this need, paid or unpaid
▪ Tendency to present in a crisis and needing unplanned care
▪ Very varied availability and quality of provision – inequity
...All leading to isolation, loneliness, dependency on family members and call
on unplanned services

5. Our response
A ‘Care Navigator’ role in primary care to work across health, social
care and third sector.
▪ Three roles:
▪ Provide patient-focussed, integrated support to co-ordinate care
around the patient and navigate the system
▪ Improve planned take up of services; reduce DNAs; reduce
unplanned demand; improve communication primary/acute care
▪ Provide ‘live’ feedback on service quality to GP commissioners -
service improvement
• Role supported by mentoring and education package – quality and
consistency

6. Makes a real difference
What the GPs say:
 “Having a patient navigator at the surgery has been revolutionary
for team working and patient care. Patients who were hard to
reach, often missed appointments, and paradoxically were frequent
users of non-elective care (e.g. OOH, A&E) have now had
comprehensive holistic assessments by a team of healthcare
professionals, all co-ordinated by the navigator.”
Dr Tahir, Barlby Surgery

7. Flexible, adaptable, scaleable:
 Piloted in primary care
 Pilot underway in a mental health team liaising with primary
care
 Fits into Out of Hospital and Integration agenda
 Can sit in health, social care, third sector, community –
structured around local strengths
 Does not require a complex infrastructure with associated costs
 Economic for a very small team, and robust for a larger one

8. Effective and Efficient: Average healthcare use
6 months before and after intervention start
GP contacts Outpatient
Significant drop
Out of hours
Significant drop
Inpatient
A&E
Significant drop
Significant drop
Significance test=Wilcoxan signed rank test

9. Potential cost savings per patient
Indicative, based on 6 months pre and post
Savings
Average Average contacts Average contacts
cost per 6 months pre 6 months post Saving:
contact intervention intervention Difference £ Saving
GP £25 8.6 4.6 -4.0 £99
Inpatient £1,825 0.4 0.08 -0.3 £584
Outpatient £160 2.9 2.3 -0.6 £96
Out of hours £45 2.3 1.2 -1.2 £52
A&E £152 1.4 0.6 -0.8 £116
£947
Costs
Navigator unit cost (incl on-costs) £303
Net savings
Potential net intervention saving per patient (over 6 months) £644
Assumes drop in activity post-intervention is all as a result of intervention. Effect of regression to the mean may reduce the calculated level of savings
However, savings may be realised over a longer period than 6 months, as modelled here. Likely savings in other aspects of care e.g. prescribing

10. Abbotts Hearing Aid centre Campden Charities Floating Housing Support Occupational Therapy
ACKC - friends & neighbours Carers Counselling Freedom pass Opthalomogy
ACKC befriending referral Carers KC Osteopathy Optician
ACKC benefits check Carers UK GP Orthopaedics Dept - St Mary's
ACKC Dementia Team CARS HF Hammersmith Hospital Palliative nurse
ACKC 'food & friends' Chelsea Theatre Health Trainers PALS
ACKC outings Chemist home delivery Healthcall (home opticians) Parkinson's Society
ACKC Practical Help CLCH Wheelchair Service Healthy Homes Peabody Tenant Support team
ACKC Shopping Service Community Alarm Service Hepatology Pepperpot
ACKC Support Broker Community Dementia Team Homeshare Scheme PhysIotherapy
ACKC Toe nail Cutting Community Diabetes Team Housing Opportunitues Team Podiatrist NHS
ACKC Toe Nail Cutting Service Community Mental HealthTeam Incontinence Service Practice Nurse
ACKC-Info & Advice Community pharmacy K&C Cruse Psychiatric Services
ACKC Escorting Cook & Taste sessions at Chelsea Theatre KCMS Quest
ACKC - Respite care Cooperative Funeral Care Learning disability Occupational Therapy Red Cross
ACKC Wayfinder Counselling Library Re-enablement Team H & F
ACKC Ageing Well sessions Crossroads Care Library Home Delivery Service Retinal Clinic
ACKC At Home Community Rehab Team Local colleges RNIB
ACKC Memory Café Cruse KC local sports facilities Samaritans
ACKC Volunteer CX Transport & Carer service Macmillan Centre at Chelwest Social Services
ACKC Decluttering Day Services Meals on wheels Stroke Association
ACKC Garden Guardians Depression Alliance Memory Service Substance Misuse Counsellor
Admiral Nurses Dietician MIND Sudanese Women's Assoc
Alcohol Resource Centre Disability Living Foundation Miranda Barry Day Centre Taxicard
Attendance allowance District Nurses Mulberry Place Activity Centre Thames Water Finance assistance
Binbrook House Support staff Dossett Box (chemists) New Horizons TMO
Blue badge DVLA appeal process NHS Direct Transport for All
British Heart Foundation Falls clinic Notting Hill Trust Vitalise Crossroads Care
Burgess Fields Support staff Falls Service Nucleus Westway Community Transport
Citizens Advice Bureau Fitness for Health Nutritionist Wiltshire farm foods
Open Age World's End Neighbourhood Advice

11. Contact
Cynthia Dize
Chief Officer
Age UK Kensington & Chelsea
1 Thorpe Close, London W10 5XL
020 8969 9105
cdize@aukc.org.uk
www.aukc.org.uk